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Horizon to Update Coding System for Laboratory Services

Effective October 15, 2021, Horizon will update our coding system for laboratory service claims to align with existing Horizon policy.

As a participating physician, you will only be reimbursed for certain laboratory

Services performed in your office. Please review Eligible Laboratory Services section in the Participating Physician and Other Health Care Professional Office Manual for details.

To access this content, please log on to NaviNet, select Horizon BCBSNJ from the My Health Plans menu and:

  • Mouse over References and Resources and select Provider Reference Materials
  • Mouse over Resources and select Manuals and User Guides
  • Select Participating Physician and Other Health Care Professional Office Manual
  • Select Policies, Procedures & General Guidelines
  • Navigate to the section, Eligible Laboratory Procedures in an Office Setting

While these requirements have clearly been documented in the physician manual, Horizon’s coding system for laboratory service claims did not consistently process claims in accordance with the policy. We will deny and no longer reimburse any claims submitted outside these documentation guidelines on and after October 15, 2021.

We will not recap any payments for claims submitted by October 15, 2021.

If you have any questions, please contact your Network Specialist.

Published on: September 15, 2021, 14:35 p.m. ET
Last updated on: September 20, 2021, 11:55 a.m. ET